| NPI | 1932958212 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 6001458-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001458-15) |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2024-05-17 |