| NPI | 1033120506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 26565) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 26265) |
| 1223G0001X Dentist, General Practice (Licence: GA DN013362) | |
| 1223P0300X Dentist, Periodontics (Licence: GA DNO13362) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2017-05-23 |