| NPI | 1982067468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901602017) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1857309) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2024-10-18 |