| NPI | 1487094678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN 21590) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.3293) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2015-09-09 |