| NPI | 1770633794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.016935) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 16935) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-10-11 |