| NPI | 1457485229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 42214) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901018582) |
| 122300000X Dentist (Licence: FL TP537) | |
| 122300000X Dentist (Licence: PA RFD000046) | |
| 122300000X Dentist (Licence: MI 2901018582) | |
| 1223P0300X Dentist, Periodontics (Licence: FL TP537) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2026-06-16 |