| NPI | 1689825622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN22812) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DNO13805) |
| 1223P0300X Dentist, Periodontics (Licence: GA DN013805) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2022-06-30 |