| NPI | 1588744197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: SC 2080) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NC 200001400179) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |