| NPI | 1184710212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 17782) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 17676) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-12-02 |