| NPI | 1174506745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 480) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401008175) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2007-12-12 |