| 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 |