| 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 |