NPI | 1811911704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602006) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025285) |
1223G0001X Dentist, General Practice (Licence: MA DN1855069) | |
Enumeration Date | 2006-07-26 |
Last Update Date | 2024-04-25 |