| NPI | 1649630492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 8229) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 10337) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2024-06-18 |