| NPI | 1619162534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901009981) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901009981) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-10-27 |