| NPI | 1508823840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 0021833) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21833) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2016-05-25 |