| NPI | 1265552491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DA031621) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037360) |
| 1223G0001X Dentist, General Practice (Licence: OH 30 - 021422) | |
| 183500000X Pharmacist (Licence: OH 03-1-17370) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-02-28 |