| NPI | 1356304182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027076) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5831) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-03-13 |