| NPI | 1275785545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN19153) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401411932) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2010-08-06 |