| NPI | 1659454155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 12424039-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019477) |
| 1223P0700X Dentist, Prosthodontics (Licence: MI 2901019477) | |
| 1223P0700X Dentist, Prosthodontics (Licence: SC 8593) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-07-29 |