| NPI | 1790367142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN28516) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 17109) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2023-08-24 |