| NPI | 1437384807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40291) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PR 2831) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2025-09-02 |