| NPI | 1255528360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ 10558) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OR D9020) |
| 1223P0300X Dentist, Periodontics (Licence: GA DN015335) | |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2021-09-08 |