| NPI | 1871732081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DNF000348) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401416194) |
| 1223P0300X Dentist, Periodontics (Licence: GA DNCS000313) | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2023-04-13 |