| NPI | 1811475239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MT 23613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203648) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2023-08-21 |