| NPI | 1043832975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH 30.026124) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026124) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-05-11 |