| NPI | 1922402429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 29010111879) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MI 2901011879) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-14 |