| NPI | 1386751220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.027779) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 45078) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2025-03-31 |