NPI | 1205835956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009858) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30016510) |
Enumeration Date | 2005-07-15 |
Last Update Date | 2018-03-28 |