| NPI | 1114914595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS024679L) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-02-0997) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-08 |