| NPI | 1235152992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 4070) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NC 3195) |
| 126800000X Dental Assistant | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2012-07-17 |