| NPI | 1548539604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MD 8421) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MD 8421) |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2011-12-19 |