| NPI | 1972818276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC 6768) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 4072) |
| 1223G0001X Dentist, General Practice (Licence: KY 8942) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30.023300) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2024-01-08 |