| NPI | 1598131757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24817) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024593) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2025-12-12 |