| NPI | 1316321177 |
|---|---|
| Former Name | MICHAEL WARREN ANDERSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13552) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D13552) |
| Enumeration Date | 2015-07-11 |
| Last Update Date | 2017-08-14 |