NPI | 1235286238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 71000195) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019026687) |
122300000X Dentist (Licence: MI 2901017827) | |
Enumeration Date | 2007-01-04 |
Last Update Date | 2007-07-10 |