| NPI | 1366576134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018739) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MI 2901018739) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |