NPI | 1992363907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 40912) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026166) |
1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026166) | |
Enumeration Date | 2019-06-04 |
Last Update Date | 2024-08-23 |