| NPI | 1407830961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30022748) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50000888) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2008-06-17 |