| NPI | 1700035524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN0013427) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN13427) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2018-10-31 |