| NPI | 1346285525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401415395) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS036823) |
| 1223P0300X Dentist, Periodontics (Licence: NC 9303) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 25309) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2024-07-17 |