| NPI | 1295749711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 14578) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NH 1282) |
| 1223G0001X Dentist General Practice (Licence: MA 12426) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2007-07-08 |