| NPI | 1740222579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID d-4093-pe) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5588) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-09-16 |