| NPI | 1376922138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204959) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH res3606) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2025-04-01 |