| NPI | 1255305116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 105811) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AK 1071) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-06-12 |