| NPI | 1205440344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.026970) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 12037) |
| Enumeration Date | 2020-09-05 |
| Last Update Date | 2022-08-18 |