| NPI | 1023160041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MI 2901017676) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 17676) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-07-07 |