| NPI | 1710111083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 290120018) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN - 10260) |
| 122300000X Dentist (Licence: GA DN013917) | |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2018-09-18 |