| NPI | 1629715305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026823) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30.026823) |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2024-03-11 |