| NPI | 1588032809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN21334) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21334) |
| 122300000X Dentist (Licence: SC 10103) | |
| 1223P0300X Dentist, Periodontics (Licence: SC 10105) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2024-08-21 |