NPI | 1386289809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026297) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.254034) |
Enumeration Date | 2019-11-07 |
Last Update Date | 2023-11-20 |