| NPI | 1073770855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MI 2901015295) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 051295) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2019-07-31 |