| NPI | 1922084722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901016002) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901016002) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901016002) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2021-07-26 |