| NPI | 1386219707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 10621) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026976) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2022-08-26 |