| NPI | 1073801510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023436) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2015-03-12 |