| NPI | 1366726234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D008914) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: UT 80275999922) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2015-06-08 |