| NPI | 1295725968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30013706) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN5441) |
| 122300000X Dentist (Licence: CA 27095) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2007-07-08 |