| NPI | 1477605509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 6714, 601) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WV 4284) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-03-20 |