| NPI | 1538721444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026085) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2019020710) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2020-12-27 |