| NPI | 1972761773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN014625) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS036552) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2014-02-17 |