| NPI | 1134132616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN24599) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30-021764) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-11-29 |