| NPI | 1194801266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 16914) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018825) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2009-12-14 |