Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2901020776 | MI |
NPI | 1063821718 |
---|---|
Provider Name | Christopher Mcwatters |
First Address | Livonia, MI 48150-1819 |
Second Address | Livonia, MI 48150-1819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |