| NPI | 1235519778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024499) |
| 122300000X Dentist (Licence: OH 30.024499) | |
| Enumeration Date | 2015-05-30 |
| Last Update Date | 2024-05-06 |