NPI | 1053549782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901020321) |
Additional Taxonomies | 122300000X Dentist (Licence: FL 755) |
Enumeration Date | 2009-07-01 |
Last Update Date | 2012-09-19 |