| NPI | 1356084784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.027653) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH RES.004438) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2024-08-09 |