| NPI | 1134595804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AK 145963) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040471) |
| 1223P0300X Dentist, Periodontics (Licence: PA DS040471) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2023-01-02 |