| NPI | 1023592490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61103820) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025406) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2022-06-22 |