| NPI | 1215335542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9537) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 9537) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2022-07-12 |