| NPI | 1821105099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN16484) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 7706) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2019-04-30 |