| NPI | 1518947605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC 1000723) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 7512) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2011-06-21 |