| NPI | 1477295426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 29521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH RES.004439) |
| 1223G0001X Dentist, General Practice (Licence: FL 29521) | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2024-10-13 |