| NPI | 1114033214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-01-7218) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-017218) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2009-09-04 |