NPI | 1245121078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901602628) |
Additional Taxonomies | 122300000X Dentist (Licence: LA S-1122) |
Enumeration Date | 2025-07-10 |
Last Update Date | 2025-08-19 |