| NPI | 1295406254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602110) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS043316) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2024-08-26 |