| NPI | 1457565384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 12050) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC 5907) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-04-24 |