| NPI | 1669928685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401418397) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600354) |
| 122300000X Dentist (Licence: VA 0401418397) | |
| 1223P0300X Dentist, Periodontics (Licence: MI 2901600354) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-08-10 |