| NPI | 1851324867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OH 16677) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MI 11336) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |