| NPI | 1154797504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NV S4-122C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9410763-9921) |
| 1223P0300X Dentist, Periodontics (Licence: UT 9410763-9921) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2024-12-09 |