| NPI | 1750340725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901018066) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54487) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2009-07-17 |