| NPI | 1669570586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VA 0401412998) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: DC DEN1000491) |
| 1223P0300X Dentist Periodontics (Licence: PA DS036545) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-09-22 |