| NPI | 1710035886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL DN17571) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: AL 5495) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-12-22 |