| NPI | 1538575493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30287) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021316) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2022-07-21 |