| NPI | 1730520727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D.007185-C) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES3373) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2023-08-02 |