| NPI | 1043597214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL DN18461) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MD 17254) |
| 1223P0300X Dentist Periodontics (Licence: VA 0401417114) | |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2023-06-28 |