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 |