| NPI | 1861535775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 7294) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 7294) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2008-11-14 |