| NPI | 1689396442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D012445) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX ETN996) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-04-29 |