| NPI | 1780632182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 1001781-15) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401008975) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-08-31 |