| NPI | 1699261495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102358) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.24772) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2024-09-22 |