| NPI | 1326236761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901010972) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30014770) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-11 |