| NPI | 1083774749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 71-00-0142) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 113) |
| 1223P0700X Dentist, Prosthodontics (Licence: OH 71-00-0142) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NE 113) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |