NPI | 1053190009 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601907) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TX 40046) |
Enumeration Date | 2023-09-27 |
Last Update Date | 2023-09-27 |