| NPI | 1689952616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11167) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA 38840) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901020546) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2020-05-21 |