| NPI | 1720085749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NM DD2136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-01-9397) |
| 1223G0001X Dentist, General Practice (Licence: NM DD2136) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2024-01-05 |