| NPI | 1124267232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AZ D7714) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MO 2006015357) |
| 1223P0300X Dentist Periodontics (Licence: HI 2261) | |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2009-02-12 |