| NPI | 1891221248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD.10311) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025065) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2023-07-18 |