NPI | 1326236761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901010972) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30014770) |
Enumeration Date | 2007-10-11 |
Last Update Date | 2007-10-11 |