| NPI | 1871019570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 8069) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-025222) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2025-05-18 |