| NPI | 1699184648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 10006) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9054856-9921) |
| 1223P0300X Dentist, Periodontics (Licence: UT 90548569921) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2022-01-11 |