| NPI | 1346331741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901015553) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: WI 5001473015) |
| 1223P0700X Dentist Prosthodontics (Licence: MI 2901015553) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |