| NPI | 1912076738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 265201-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025304) |
| 122300000X Dentist (Licence: OR D10160) | |
| 122300000X Dentist (Licence: UT 265201) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-01-14 |