| NPI | 1538869029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044523) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.027456) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2024-07-11 |