| NPI | 1891889937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22973) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: TX 22973) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2009-06-24 |