| NPI | 1225273535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60091148) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022919) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2016-12-22 |