| NPI | 1740549518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30.026723) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 057074) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2024-02-14 |