| NPI | 1114232527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VA 0401413670) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: VA 0442000102) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2023-02-28 |