| NPI | 1386215424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901602398) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN25996) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.026593) | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2025-02-28 |