| NPI | 1770797052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901008572) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 19075) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |