| NPI | 1538370143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN008724) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA 8724) |
| 1223P0300X Dentist, Periodontics (Licence: GA 1223P0300X) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-03-07 |