| NPI | 1629558507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901602000) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2019011336) |
| 1223G0001X Dentist General Practice (Licence: CO DEN.00203754) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-12-20 |