| NPI | 1558799148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ME DEN4865) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021114) |
| 1223E0200X Dentist, Endodontics (Licence: MI 2901600799) | |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2021-05-23 |