NPI | 1598285454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D13918) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ME DEN4572) |
Enumeration Date | 2017-06-22 |
Last Update Date | 2019-10-31 |