| NPI | 1508271529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.8514 GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES3450) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2024-02-06 |