| NPI | 1447342571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 61303) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901019331) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2013-03-11 |