| NPI | 1538370135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020191) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0022602) |
| 122300000X Dentist (Licence: MI 2901020191) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-02-28 |