| NPI | 1972594307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN29633) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN29633) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2024-10-02 |