| NPI | 1487000998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23625) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30025552) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2018-11-13 |