| NPI | 1710945308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901015675) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MI 2902014138) |
| 126800000X Dental Assistant | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-03-07 |