| NPI | 1750505814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 9795) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DN013389) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2023-02-22 |