| NPI | 1518343359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 35960) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024589) |
| 122300000X Dentist (Licence: PA DS040676) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2023-09-15 |