| NPI | 1982798716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN011384) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD10916GD) |
| 1223P0300X Dentist, Periodontics (Licence: SC DGD10917DS) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-09-24 |