| NPI | 1437539665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011437) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI P340847778775) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2026-04-28 |