| NPI | 1588111397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022077) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901022077) |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2017-03-07 |