| NPI | 1588644280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 017716) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA 015485) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2018-03-17 |