| NPI | 1841728839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 35867) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901022167) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2020-08-06 |