| NPI | 1013270016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 023789) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.023789) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-12-16 |