| NPI | 1730149840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 103569) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 22541) |
| 1223P0300X Dentist, Periodontics (Licence: TN 11654) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2026-07-08 |