| NPI | 1235216110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901018230) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI BM8955760) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2024-06-10 |