| NPI | 1457354870 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.023585) | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 26430) | 
| 1223G0001X Dentist, General Practice (Licence: IL 19-15320) | |
| 1223G0001X Dentist, General Practice (Licence: AK DENT1384) | |
| 1223G0001X Dentist, General Practice (Licence: WI 1002349-15) | |
| Enumeration Date | 2005-05-31 | 
| Last Update Date | 2025-09-11 |