| NPI | 1427305580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: MI 2901600916) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 61669) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2021-05-19 |