NPI | 1972859627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 4346-22) |
Additional Taxonomies | 122300000X Dentist (Licence: OH RES.3249) |
Enumeration Date | 2012-07-31 |
Last Update Date | 2023-03-07 |