| NPI | 1114157187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-023216) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028059) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2014-02-18 |