| NPI | 1396864021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN11592) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL 11592) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2024-11-20 |