NPI | 1174188692 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025721) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 16883) |
Enumeration Date | 2019-05-09 |
Last Update Date | 2023-01-08 |