NPI | 1134408198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-023506) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023506) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 30-023506) | |
Enumeration Date | 2011-08-09 |
Last Update Date | 2023-03-17 |