| NPI | 1720067481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 10361) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901016647) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-10-16 |