| NPI | 1750123048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027838) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 12476) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2025-05-30 |