| NPI | 1295113736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024982) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS104829) |
| 122300000X Dentist (Licence: AZ D011220) | |
| Enumeration Date | 2015-05-17 |
| Last Update Date | 2023-02-03 |