| NPI | 1568783579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE 60108665) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS038148) |
| 1223P0300X Dentist, Periodontics (Licence: FL DN 18124) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2010-06-14 |