| NPI | 1346476660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 24579) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30-022977) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2009-06-01 |