NPI | 1629444898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64579) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026047) |
1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026047) | |
Enumeration Date | 2015-08-11 |
Last Update Date | 2023-11-01 |