| NPI | 1003476581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24924) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004125) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-03-30 |