| NPI | 1831577352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027972) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021547) |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2026-02-12 |