| NPI | 1861507295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13169) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16304) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901015080) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-06-23 |