| NPI | 1003258641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE60402132) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011502A) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2022-01-28 |