| NPI | 1699297200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022223) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MI 2901022223) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2023-08-15 |