| NPI | 1295479640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29374) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 29374) |
| 1223G0001X Dentist, General Practice (Licence: OH RES.004448) | |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2024-07-12 |