| NPI | 1205980604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: RI 02496) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MA 11023) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |