| NPI | 1366119877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11550) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OR D11550) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2026-01-02 |