| NPI | 1891575700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NE 7982) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN28570) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2023-11-27 |