| NPI | 1689083040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30.024919) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NV 6553) |
| Enumeration Date | 2014-08-10 |
| Last Update Date | 2017-01-17 |