| NPI | 1174686257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 16885) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 29751) |
| 1223G0001X Dentist, General Practice (Licence: FL DN9726) | |
| 1223G0001X Dentist, General Practice (Licence: AZ 2867) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |