| NPI | 1669031381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NV S4-127) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10285) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2025-06-25 |