| NPI | 1043297153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE00010960) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: ID D-3382) |
| 1223P0300X Dentist, Periodontics (Licence: UT 376097-9921) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-09-14 |