| NPI | 1831709633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AR 4647) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: TX ETN793) |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2024-11-11 |