| NPI | 1851956882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN27827) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002022-15) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2023-05-02 |