| NPI | 1023102522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23641) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-022421) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-05-04 |