| NPI | 1518116615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ME 4415) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019927) |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 056026) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2016-11-02 |