| NPI | 1225292121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR DF0028) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN S66) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2015-05-12 |