| NPI | 1790344406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 0006625) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: AL 0006625) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2019-06-07 |