| NPI | 1407433139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417854) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.028237) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2025-12-16 |