| NPI | 1154330694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 16794) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401007638) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2024-02-22 |