| NPI | 1013957299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30021745) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 21745) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-07-21 |