NPI | 1053576587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OH 3023080) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019906) |
Enumeration Date | 2008-07-24 |
Last Update Date | 2022-06-18 |