| NPI | 1407085335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024582) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19188) |
| 1223G0001X Dentist, General Practice (Licence: CA 63041) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2022-07-21 |