NPI | 1154738474 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.024872) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415118) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-07-18 |
Last Update Date | 2022-07-18 |