| NPI | 1447366786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: GA 10285) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: GA GA10285) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2022-08-11 |