| NPI | 1265847339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MI 2901021329) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021329) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2024-07-30 |