| NPI | 1336176932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901014626) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 014526) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901021723) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-07-14 |