| NPI | 1811911704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602006) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025285) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1855069) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-04-25 |