| NPI | 1891892832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010915) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023874) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-09-08 |