NPI | 1518453059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600407) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041818) |
Enumeration Date | 2018-07-09 |
Last Update Date | 2022-03-16 |