| NPI | 1063619492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901019657) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019657) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-12-16 |