| NPI | 1629663166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MI 2901022763) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901022763) |
| Enumeration Date | 2021-03-06 |
| Last Update Date | 2021-07-15 |