| NPI | 1881116002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9134) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025188) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2022-08-15 |