| NPI | 1356034789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL D.007218-C1) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 109310) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2026-08-11 |