| NPI | 1497023196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: OK 72) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901020564) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2023-12-14 |