| NPI | 1821180886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 23139) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OK 5730) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-08-02 |