| NPI | 1932639796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204291) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025149) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025149) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-11-11 |