| NPI | 1043390719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: IA 40049) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MI 2901009206) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |