| NPI | 1780363556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.027982) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011905) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-07-11 |