NPI | 1225784705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.027065) |
Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004496) |
122300000X Dentist (Licence: OH 30.027065) | |
Enumeration Date | 2022-02-23 |
Last Update Date | 2023-04-04 |