| NPI | 1437350071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 7216) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410412) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2008-03-07 |