| NPI | 1710369194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6224) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021590) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2025-08-18 |