| NPI | 1215190970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901019888) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019888) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2011-07-08 |