| NPI | 1710035464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNF000474) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 20215) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2026-06-29 |