| NPI | 1043307770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 5511FLA) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 4764) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |