| NPI | 1558511493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN23154) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 2824) |
| 1223P0300X Dentist, Periodontics (Licence: PR 125980) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2019-12-17 |