NPI | 1588223788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.025853) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025853) |
122300000X Dentist (Licence: KS 61721) | |
Enumeration Date | 2019-06-11 |
Last Update Date | 2023-03-28 |