| NPI | 1942045612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 13731) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2026-03-11 |