| NPI | 1184988578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014936) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020636) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2024-02-08 |