| NPI | 1548886252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN25000) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN25000) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2025-12-05 |