| NPI | 1891833034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2226) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901008368) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2011-10-20 |