| NPI | 1215414123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: UT 12196790-9924) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NE 7493) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2022-01-17 |