NPI | 1558128066 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027536) |
Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
Enumeration Date | 2024-03-01 |
Last Update Date | 2024-05-22 |