| NPI | 1639544265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2952000814) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021724) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2023-01-23 |