| NPI | 1851346613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: WI 6063-015) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: GA DN012270) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-09 |