| NPI | 1437624574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.025580) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415956) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |