| NPI | 1619548955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03687) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026479) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.026479) | |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2024-01-08 |