| NPI | 1477668218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016481) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30020255) |
| 122300000X Dentist (Licence: IL 019023859) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |