NPI | 1518147016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901011253) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901011253) |
Enumeration Date | 2007-11-13 |
Last Update Date | 2007-11-13 |