| NPI | 1699518324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401419639) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH res.004827) |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2025-08-03 |