| NPI | 1972708030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.024983) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21859) |
| 122300000X Dentist (Licence: PA DS037575) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2017-10-13 |