NPI | 1346476660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24579) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-022977) |
Enumeration Date | 2009-06-01 |
Last Update Date | 2009-06-01 |