| NPI | 1598848319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7710) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 18252) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 15825) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2009-09-03 |