| NPI | 1689908774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA ds038041) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC DEN1000936) |
| 1223P0300X Dentist, Periodontics (Licence: VA 0401412872) | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2010-08-06 |