| NPI | 1598496598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12753) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026914) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2025-01-18 |