| NPI | 1174668156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D6715) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA D8616) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-02-14 |