| NPI | 1972619203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN 15531) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 19496) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-10-04 |