| NPI | 1215311667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 6221) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 6221C1) |
| 1223G0001X Dentist, General Practice (Licence: AL 6221) | |
| 1223P0300X Dentist, Periodontics (Licence: AL AL6221) | |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2021-09-20 |