| NPI | 1801146840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MD 17935) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MI 2901020454) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2023-05-15 |