| NPI | 1801068226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8882) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901015774) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2024-04-14 |