| NPI | 1346930997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027414) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401419362) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2025-04-04 |