| NPI | 1477761849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411513) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 019100) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-03-24 |