| NPI | 1558434480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MI 2901016909) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MI 16909) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2021-10-01 |