| NPI | 1609188531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901022570) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO Den.00201849) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2019-03-28 |