| NPI | 1508039660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN17899) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CO DEN-9692) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2015-05-28 |