| NPI | 1780647388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN012047) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 12047) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2015-09-30 |