| NPI | 1255010351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 10906) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.027307) |
| 1223G0001X Dentist, General Practice (Licence: NC 14075) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-05-21 |