| NPI | 1740244102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS031189L) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025689) |
| 122300000X Dentist (Licence: PA DS031189L) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025689) | |
| 1223G0001X Dentist, General Practice (Licence: MD MD 13493) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-02-24 |