| NPI | 1851595250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11685) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037146) |
| 122300000X Dentist (Licence: OH 30.022626) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-10-23 |