| NPI | 1417199233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.023048) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 2651) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2016-12-01 |