| NPI | 1396981379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC DEN3951) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS025054L) |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2023-02-24 |