| NPI | 1134449234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020286) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24759) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2024-04-09 |