| NPI | 1881214807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN123699) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 14050) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2025-02-16 |