| NPI | 1811349913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN10576) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30022972) |
| 122300000X Dentist (Licence: TN DS4308) | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |