| NPI | 1114586203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602887) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11325173-9921) |
| 1223G0001X Dentist, General Practice (Licence: TX 40980) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2026-02-23 |