| NPI | 1801448527 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600209) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600209) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-12-23 |