| NPI | 1316108772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 7331989) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.022777) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2009-07-17 |