| NPI | 1295704500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 290160204) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.022704) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-03-12 |