| NPI | 1588951958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OK 69) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6319) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2018-03-27 |