| NPI | 1376365858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602420) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 110885) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-11-08 |