| NPI | 1063702207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901021422) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: FL DN22643) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2018-05-08 |