| NPI | 1861692360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 4947499-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1243) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2019-09-16 |