| NPI | 1558497081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 6043) |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0300X Dentist Periodontics | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2025-09-11 |