| NPI | 1538720651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26245) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004133) |
| 1223G0001X Dentist, General Practice (Licence: FL 26245) | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2023-04-14 |