NPI | 1174604110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-9751) |
Additional Taxonomies | 122300000X Dentist (Licence: MN 10403) |
Enumeration Date | 2006-10-18 |
Last Update Date | 2024-04-03 |