| NPI | 1023165651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-020909) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS-030590-L) |
| 122300000X Dentist (Licence: MI 2901020863) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-05-26 |