| NPI | 1245121078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901602628) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA S-1122) |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-08-19 |