NPI | 1821184698 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OH 30018333) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH 018333) |
Enumeration Date | 2006-10-05 |
Last Update Date | 2018-12-07 |