| NPI | 1275848582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID D4420PE) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: ID D4420EN) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2012-10-15 |