| NPI | 1073871307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN12524) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 014567) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |