| NPI | 1427333822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D9674) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60022749) |
| 122300000X Dentist (Licence: MI 2901019827) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |