| NPI | 1578090395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VA 0401417686) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: DC DEN2000045) |
| 1223P0300X Dentist Periodontics (Licence: MD 17409) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-11-19 |