| NPI | 1154424588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 13862) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901009874) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2024-02-15 |