| NPI | 1619083607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401008958) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC 5855) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2014-05-27 |