| NPI | 1164581302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901016883) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901016833) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2023-12-04 |