| NPI | 1699220384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 9691) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8818 GD) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2023-03-07 |