| NPI | 1790812089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL 10616) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9236) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2015-01-20 |