NPI | 1770623969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MI 2901022115) |
Additional Taxonomies | 122300000X Dentist (Licence: CA D1036395) |
122300000X Dentist (Licence: CA 36395) | |
Enumeration Date | 2007-02-07 |
Last Update Date | 2023-09-11 |