| NPI | 1780178822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VT 016.0134160) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 2.013571) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-09-24 |