| NPI | 1831477819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NM DD3986) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 5871 C1) |
| 122300000X Dentist (Licence: NM DD3986) | |
| 122300000X Dentist (Licence: TX 29230) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2016-09-21 |