| NPI | 1487686770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 13952) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401006367) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-05-18 |