| NPI | 1235281049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 5059) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30021554) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-10-12 |