| NPI | 1881808657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 10598) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 20609) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2023-10-09 |