| NPI | 1659032431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 13965903-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13965903-9926) |
| 122300000X Dentist (Licence: MO 2021018860) | |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2024-10-28 |