| NPI | 1659439503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 4318) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 16137) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2015-05-04 |