| NPI | 1063683092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 260078) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 21923) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |