NPI | 1659561967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14102) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55801) |
Enumeration Date | 2007-08-01 |
Last Update Date | 2019-02-27 |