| NPI | 1285948414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN016082) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029281) |
| 1223P0300X Dentist, Periodontics (Licence: FL DN 18094) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 021.002499) | |
| 1223P0300X Dentist, Periodontics (Licence: MO 2012010128) | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2020-10-19 |