| NPI | 1740266170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 6021-015) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IA 07983) |
| Enumeration Date | 2005-12-18 |
| Last Update Date | 2007-07-08 |