| NPI | 1205985736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 10030) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 21832) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-05-07 |