| NPI | 1942303409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MO DE015523) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO DE015523) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2014-04-29 |