| NPI | 1043276116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DTP 118) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS 26123) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2023-03-07 |