| NPI | 1497917132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 4301091837) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 2344) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2016-01-18 |