| NPI | 1417330705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401418304) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021535) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2023-02-26 |