| NPI | 1932302528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901012305) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 12305) |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2021-06-09 |