NPI | 1659865020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600389) |
Additional Taxonomies | 122300000X Dentist (Licence: MN D14060) |
Enumeration Date | 2018-06-19 |
Last Update Date | 2020-02-07 |