| NPI | 1447384151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 022732) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8356) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2021-06-04 |