| NPI | 1710413794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: OK 93) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: TX 33125) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-04-18 |