| NPI | 1770074395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12630) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025421) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2024-05-21 |