| NPI | 1700994852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IA 06580) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CO 5910) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2018-09-27 |