| NPI | 1790785103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 19547) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MI 12471) |
| 1223E0200X Dentist, Endodontics (Licence: CA 35244) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-08 |