| NPI | 1215084157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: OH 71-000179) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 71-000179) |
| 122300000X Dentist (Licence: OH 0179) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2013-05-21 |