| NPI | 1548330004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 350703) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV S4-138C) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2025-11-14 |