| NPI | 1144273699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11211) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901016753) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-07-01 |