| NPI | 1023248408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN18669) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 1855123) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2019-08-12 |