| NPI | 1760590129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL Dn15286) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN15286) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2020-09-07 |