| NPI | 1164420584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.018750) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 18750) |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2023-05-11 |