| NPI | 1992031603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TX 29864) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037973) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2024-01-30 |