| NPI | 1669577599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016810) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 16810) |
| 122300000X Dentist (Licence: MI 2091016810) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-08-13 |