| NPI | 1922019462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7383) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 17894) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-10-29 |