| NPI | 1336106996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.022996) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08215) |
| 122300000X Dentist (Licence: KY 8449) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2022-08-22 |