| NPI | 1699980920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D7175) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 34761) |
| 1223P0300X Dentist, Periodontics (Licence: NV S4-83C) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2021-12-17 |