| NPI | 1245645175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 30023) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30023) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2020-10-23 |