| NPI | 1427029511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC SC2339) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DN008953) |
| 1223P0300X Dentist, Periodontics (Licence: LA 3175) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2007-09-05 |