| NPI | 1497197271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN22236) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0442000190) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2016-09-30 |