| NPI | 1487271896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122597) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026232) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2022-03-03 |