| NPI | 1417939281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022470) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS035374) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2014-11-06 |