| NPI | 1194344580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901600453) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600453A) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2022-08-01 |