| NPI | 1033662937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 31905) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31905) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2026-07-28 |