| NPI | 1588914543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN21004) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2012018306) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2022-02-13 |