| NPI | 1336211614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS028499L) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA 00007825) |
| 1223P0300X Dentist, Periodontics (Licence: WI 1001067-15) | |
| 1223P0300X Dentist, Periodontics (Licence: TN 11876) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-08-11 |