| NPI | 1316055254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901020584) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-026386) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-03-05 |