| NPI | 1093044398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013657) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017937) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2023-05-21 |