| NPI | 1255585725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 7994731-9924) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57636) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2024-11-12 |