Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10007 | MI |
NPI | 1063441251 |
---|---|
Provider Name | George Moricz |
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 | 01/07/2006 |
Last Update Date | 14/01/2008 |