| NPI | 1417401233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 22225) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025456) |
| 1223G0001X Dentist, General Practice (Licence: KY 10237) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2024-07-01 |