| NPI | 1720289549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 25319) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS008422) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-05-03 |