| NPI | 1992919633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 9557) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MI 2901018862) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-07-07 |