| NPI | 1659927937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600221) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2023-11-14 |