| NPI | 1982340444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418085) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026946) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-06-05 |