| NPI | 1467563809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901601231) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR DF0043) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.021010) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-08-29 |