| NPI | 1659402527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL DN8366) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: RI DEN01641) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2016-06-03 |