| NPI | 1396399150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901023174) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901023174) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2025-07-24 |