| NPI | 1386774503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI D134620) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MI D134620) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2025-09-11 |