| NPI | 1437383684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 25950) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17995) |
| Enumeration Date | 2009-05-03 |
| Last Update Date | 2013-04-04 |