| NPI | 1174544209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 9181) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 13329) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2007-07-08 |