| NPI | 1043633415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 858) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.014502) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2014-01-21 |