| NPI | 1417951781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 22695) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 106233) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2010-08-09 |