| NPI | 1982068771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011362) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024995) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2022-08-04 |