| NPI | 1982711065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DTP610) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 12542) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-06-23 |