| NPI | 1134316144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: DE G1-0001261) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 051281) |
| 1223P0300X Dentist Periodontics (Licence: PA DS037447) | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2009-02-23 |