| NPI | 1639725641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26513) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.027328) |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2026-04-21 |