| NPI | 1134501414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901021814) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE61557896) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2024-08-22 |