| NPI | 1528092178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901019327) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019327) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2021-05-14 |