| NPI | 1053835017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN27728) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025987) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-09-27 |