| NPI | 1053168120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602284) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2952000835) |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-07-18 |