| NPI | 1184504029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027874) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045400) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2026-02-19 |