| NPI | 1356578025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401413327) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN18250) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2020-07-04 |