NPI | 1023132172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901010473) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901010473) |
Enumeration Date | 2007-03-16 |
Last Update Date | 2007-07-08 |