| NPI | 1396230884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN122298) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30025509) |
| 1223G0001X Dentist, General Practice (Licence: GA DN122298) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2023-05-31 |