NPI | 1740501048 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30-023209) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023209) |
Enumeration Date | 2010-06-21 |
Last Update Date | 2011-05-27 |