| NPI | 1225192545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901020160) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30-022903) |
| 1223G0001X Dentist General Practice (Licence: FL DN16442) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2012-02-28 |