| NPI | 1578652616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN013245) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DNCS000384) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-04-13 |