| NPI | 1841539905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901020879) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PA DS038617) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2015-07-14 |