| NPI | 1669894994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.023982) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH Res.3325) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2020-07-07 |