| NPI | 1093167413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 13594) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042901) |
| 122300000X Dentist (Licence: MA DN1857732) | |
| 122300000X Dentist (Licence: MI 2901022022) | |
| 122300000X Dentist (Licence: OH 30.024959) | |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2024-04-05 |