| NPI | 1104363019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE60722033) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 019.031420) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2018-04-14 |