| NPI | 1104548148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901601548) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2952000800) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2022-11-14 |