| NPI | 1215032057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PR 2118) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 2118) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-05-05 |