| NPI | 1669455945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IA 40234) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE00009894) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2024-10-18 |