| NPI | 1770272163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29186) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.027614) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2025-11-03 |