| NPI | 1588957799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MI 2901020389) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901020389) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2021-12-16 |