| NPI | 1427121813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 15890) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901015890) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-09-23 |