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 |