| NPI | 1477846632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 6169) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9111) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2024-11-07 |