| NPI | 1730213000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901019121) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI MI2901019121) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2011-12-01 |