| NPI | 1851730923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN20166) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20166) |
| 1223P0300X Dentist, Periodontics (Licence: MO 2023018477) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2026-08-19 |