| NPI | 1891909842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D06240) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6240) |
| 1223P0300X Dentist, Periodontics (Licence: MO 2021030372) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-06-12 |