| NPI | 1285721688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 20949) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 6510) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901014260) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |