| NPI | 1457665416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D010898) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024597) |
| 1223G0001X Dentist, General Practice (Licence: AZ D010898) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2022-07-25 |