| NPI | 1952924516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901600568) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600568APP20) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-06-15 |