| NPI | 1033232764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018640) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901018640) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901018640) | |
| 207L00000X Anesthesiology (Licence: IN 01068260A) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2013-07-12 |