| NPI | 1326481995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D010692) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28733) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-06-16 |