| NPI | 1548377799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 2793) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 6220) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |