| NPI | 1740524586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D9106) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020580) |
| Enumeration Date | 2012-11-17 |
| Last Update Date | 2019-01-05 |