Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 20 | MT |
NPI | 1891910170 |
---|---|
Provider Name | Mr. Nicholas Aaron Hansemann |
First Address | Helena, MT 59602-0539 |
Second Address | Helena, MT 59602-0215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150093 | (05) | MT |