NPI | 1194971879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OH 71.000281) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 40158) |
Enumeration Date | 2008-08-13 |
Last Update Date | 2023-07-24 |