| NPI | 1285967521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 29788) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020111) |
| 122300000X Dentist (Licence: TX 29788) | |
| 1223G0001X Dentist, General Practice (Licence: TX 29788) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MI 2901020111) | |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2022-03-14 |