| NPI | 1942270244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 22243) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22243) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-07-03 |