| NPI | 1598077414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020259) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 20259) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2021-04-19 |