NPI | 1144470295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901021438) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 31604) |
Enumeration Date | 2008-09-25 |
Last Update Date | 2016-09-11 |