| NPI | 1417389172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN20817) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 20817) |
| 122300000X Dentist (Licence: MI 2901021068) | |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2022-01-19 |