| NPI | 1770923575 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 290101005) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020908) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2022-01-13 |