| NPI | 1770152480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.027668) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61880) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2024-11-26 |