| NPI | 1669802807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MI 2901021970) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64727) |
| 122300000X Dentist (Licence: IL 019029514) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2018-10-30 |