| NPI | 1336266436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SD M981) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NE 6427) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |