| NPI | 1578638375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 2002003037) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2002003037) |
| 1223P0300X Dentist, Periodontics (Licence: IL 021.001930) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2023-01-20 |