| NPI | 1831822584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 2022024594) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KS 62286) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2026-07-29 |