| NPI | 1245493048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016164) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: OH 30.024848) |
| 122300000X Dentist (Licence: WI 7186) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2017-04-13 |