| NPI | 1740840388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042964) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH RES.004135) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-04-04 |