| NPI | 1447757968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901601130) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DNF000445) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-08-29 |