| NPI | 1750437885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS0244537L) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA A14701) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2016-10-18 |