| NPI | 1588117345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 1076) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9744) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2022-11-15 |