NPI | 1497097448 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022068) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032301) |
122300000X Dentist (Licence: OH 30.025628) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-03-17 |
Last Update Date | 2021-04-28 |