| NPI | 1528133386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30022493) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0023658) |
| 1223G0001X Dentist General Practice (Licence: KS 60243) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-09-02 |