NPI | 1215220264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901020373) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MI 2901020373) |
Enumeration Date | 2011-05-24 |
Last Update Date | 2015-09-29 |