| NPI | 1649347428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN18015) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 017380) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-09-15 |