| NPI | 1285016642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.24831) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.3597) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2016-06-21 |