| NPI | 1801032198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901011910) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901011910) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |