| NPI | 1679069660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL D.0006524-C1) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL 26152) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2025-03-30 |