| NPI | 1174713853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901020163) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011031A) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2025-09-24 |