| NPI | 1679718332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS038170) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901019723) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2011-07-20 |