| NPI | 1881328797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901601394) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN31316) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2026-03-28 |