| NPI | 1477634574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN014751) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30022065) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-07-07 |