| NPI | 1275255655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2952000797) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 15974) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2023-12-19 |