| NPI | 1306848049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 13494) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401008490) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2016-01-20 |