| NPI | 1376596189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 9549) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 9549) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-07-08 |