NPI | 1770074395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12630) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025421) |
Enumeration Date | 2018-05-21 |
Last Update Date | 2024-05-21 |