| NPI | 1932196383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020897) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 050601-1) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-09-07 |