| NPI | 1588098628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS105946) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 000093) |
| 1223P0300X Dentist, Periodontics (Licence: TX 33123) | |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2022-01-18 |