| NPI | 1518414630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 10375) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8804) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-03-16 |