| NPI | 1871519579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6136) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WI 6136-15) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-09-14 |