| NPI | 1891707428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 12016) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 254685) |
| 1223P0300X Dentist, Periodontics (Licence: FL DN12016) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-26 |