| NPI | 1821172784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801085236) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901012521) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-04-05 |