| NPI | 1578985495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OR D11565) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901021710) |
| 1223P0700X Dentist, Prosthodontics (Licence: VA 0401414234) | |
| 1223P0700X Dentist, Prosthodontics (Licence: IL 019.032507) | |
| Enumeration Date | 2014-01-11 |
| Last Update Date | 2022-07-04 |