| NPI | 1003052895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 5000425-015) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WI 5000425015) |
| Enumeration Date | 2008-12-28 |
| Last Update Date | 2008-12-28 |