| NPI | 1073606380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D.6783-C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30016143) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-03-09 |