| NPI | 1336978188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.028235) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 110391) |
| 122300000X Dentist (Licence: NH 05159) | |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2026-01-12 |