| NPI | 1518269000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020317) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 26330) |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2019-09-12 |