| NPI | 1629378807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 40178) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 16792) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2022-07-21 |