| NPI | 1801187174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DNF000424) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DNCS000584) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2024-03-25 |