| NPI | 1801382866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-DA-5225) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH RES.003954) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: ID D-DA-5225) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2025-05-02 |