| NPI | 1639149107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 11067) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NE 5973) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2008-02-14 |