| NPI | 1548445711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 23754) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA ds037380) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2008-07-02 |