| NPI | 1891074860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-023562) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038737) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2024-05-19 |