| NPI | 1780779652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022689) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12010137B) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-08-29 |