| NPI | 1073618005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30014171) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901010264) |
| 122300000X Dentist (Licence: PA DS027451R) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |