| NPI | 1144570938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D010510) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN D11731) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2022-02-27 |