| 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 |