| NPI | 1225183684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30018576) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35811) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |