| NPI | 1245075381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 2516) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.027548) |
| 122300000X Dentist (Licence: IL 019.035698) | |
| Enumeration Date | 2024-06-29 |
| Last Update Date | 2025-08-18 |