| NPI | 1629706999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA RFD000062) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401418092) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2023-10-30 |