| NPI | 1396342762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9381) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: SC 10259) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2023-02-13 |