| NPI | 1972661734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23710) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 13801) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-08-25 |