| NPI | 1790185528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN S210) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401416515) |
| 1223P0300X Dentist, Periodontics (Licence: PA RFD000041) | |
| 1223P0300X Dentist, Periodontics (Licence: MN S210) | |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2024-09-03 |