| NPI | 1124757554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.027244) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38505) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-01-10 |