| NPI | 1588702666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 6780) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30023899) |
| 1223G0001X Dentist General Practice (Licence: WV 4233) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-11-12 |