| NPI | 1356656896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS039521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023207) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2025-03-03 |