NPI | 1487180337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025058) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025058) |
Enumeration Date | 2017-05-11 |
Last Update Date | 2021-08-17 |