| NPI | 1932583705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN21076) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DN123661) |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2025-01-17 |