| NPI | 1326206814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NM dd2472) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NM dd2472) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2008-05-30 |