| NPI | 1982125837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 10709) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10709) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2024-05-02 |