| NPI | 1982831749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019979) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019979) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2024-11-30 |