| NPI | 1679705131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 7399405-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 73994059921) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2017-02-20 |