| NPI | 1184603243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NM DD1382) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 12592) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2014-08-26 |