| NPI | 1417064437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401411550) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 28850) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-07-12 |