| NPI | 1598774853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6543) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901017755) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-04-21 |