| NPI | 1699282822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 21731) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 21731) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2019-01-02 |