| NPI | 1891819934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MI 2901017077) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017077) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2008-06-17 |