| NPI | 1356516637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 24124) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 7888) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2021-08-23 |