| NPI | 1609805464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7985) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2952000838) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2023-09-27 |