| NPI | 1356012702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401417676) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC DEN2000471) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2026-07-18 |