| NPI | 1174702542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC 1001842) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 102115) |
| 1223P0300X Dentist, Periodontics (Licence: TX 27324) | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2025-01-14 |