| NPI | 1033349428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32660) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023019) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2018-04-09 |