| NPI | 1396868584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS 035675) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DN013545) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2008-07-23 |