| NPI | 1346517000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401413657) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037679) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2020-10-06 |