| NPI | 1598782435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 3277) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: SC 3277 &450) |
| 1223P0300X Dentist, Periodontics (Licence: SC 0450) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2017-02-13 |