| NPI | 1063809101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NV S4-124C) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DF11069) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2023-03-02 |