| NPI | 1245469618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10067) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24699) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.023362) | |
| 1223G0001X Dentist, General Practice (Licence: NC 10623) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2023-05-19 |