| NPI | 1578092771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 16369) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC DEN1002104) |
| 1223G0001X Dentist, General Practice (Licence: MD 16369) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2020-07-16 |