| NPI | 1366611014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 28720) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE00010989) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2018-11-14 |