| NPI | 1083911846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 29894) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 58699) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2020-12-23 |