| NPI | 1245487453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412434) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 049-23517) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2010-01-12 |