NPI | 1609214105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024057) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414004) |
Enumeration Date | 2013-06-06 |
Last Update Date | 2013-08-01 |