| NPI | 1134234826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901014928) |
| Additional Taxonomies | 126800000X Dental Assistant |
| 124Q00000X Dental Hygienist (Licence: MI L551022) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-02-11 |