| NPI | 1972563732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401004561) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-01-9666) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2025-09-11 |