| NPI | 1740572700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901013840) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 105951) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2011-05-10 |