NPI | 1770505257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13506) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN FF42) |
1223G0001X Dentist, General Practice (Licence: NY 042440) | |
Enumeration Date | 2006-07-24 |
Last Update Date | 2023-08-21 |