| NPI | 1487359063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30.027576) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH RES.004584) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-08-14 |