| NPI | 1538420500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2952000722) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 40127) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2022-03-03 |