NPI | 1407896780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30022165) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.022165) |
Enumeration Date | 2006-06-07 |
Last Update Date | 2019-05-16 |