| NPI | 1427286848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-023193) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020048) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2011-08-09 |