| NPI | 1457570863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901011507) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 63907) |
| 1223G0001X Dentist, General Practice (Licence: IL 019026130) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2016-12-06 |