| NPI | 1730342676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TX 23833) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0023833) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2012-08-14 |