| NPI | 1851969042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 26659) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WV 4536) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-09-03 |