| NPI | 1952474868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 30-01-9124) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901016846) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-02-23 |