| NPI | 1942439492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6119) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OK 65) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2019-11-18 |