| NPI | 1790740322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: HI 2192) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 52815) |
| 1223P0300X Dentist, Periodontics (Licence: IL 019018177) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2015-02-05 |