| NPI | 1447929195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401419324) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NH 2950) |
| 1223P0300X Dentist, Periodontics (Licence: MA DL14958) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2025-04-07 |