NPI | 1659728061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: PR 3420) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 060843) |
122300000X Dentist (Licence: OH 30025184) | |
Enumeration Date | 2016-05-16 |
Last Update Date | 2023-02-28 |