| NPI | 1831404078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9812) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020292) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2023-11-10 |