| NPI | 1356691638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 29736) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 60903) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2014-07-09 |