| NPI | 1588142632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS041713) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041713) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2020-06-08 |