| NPI | 1346909819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 185813) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901602333) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2025-09-26 |