| NPI | 1720147853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn17781) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019307) |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN17781) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2022-01-19 |