| NPI | 1376799445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AZ 8075) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 60014) |
| 1223P0300X Dentist Periodontics (Licence: MD 14245) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2019-06-18 |