| NPI | 1295129104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11030) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.24811) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2019-06-01 |