NPI | 1598077414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020259) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 20259) |
Enumeration Date | 2010-07-08 |
Last Update Date | 2021-04-19 |