| NPI | 1073771580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 2022012734) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KS 61988) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-04-28 |