| NPI | 1548425390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 17789) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN17789) |
| 1223P0300X Dentist, Periodontics (Licence: FL 17789) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2010-01-05 |