| NPI | 1184613309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901018847) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018847) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2015-04-03 |