| NPI | 1417797176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 4841) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30.027573) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2025-07-25 |