| NPI | 1154557072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 24797) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: LA S-461) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2009-11-12 |