| NPI | 1578786794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL DN16276) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NC 10536) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2018-05-02 |