| NPI | 1376239905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.028077) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN30175) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2025-06-13 |