| NPI | 1740929561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13415) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004467) |
| 1223G0001X Dentist, General Practice (Licence: OH RES.004467) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-08-03 |