| NPI | 1497906309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30023589) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN013780) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2012-08-22 |