| NPI | 1467889378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA FAC-40224) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 71.000273) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2023-07-13 |