| NPI | 1811414139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7439) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022396) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2024-07-15 |