| NPI | 1699089086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20752) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023262) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2019-12-02 |