| NPI | 1427785237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601499) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901601499) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2024-07-16 |