| NPI | 1194491514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: OH 30.026643) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN26284) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-12-14 |