| NPI | 1336716877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401418806) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 18406) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2024-11-21 |