| NPI | 1164509014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 046575) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901018781) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2019-08-14 |