| NPI | 1528029733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30013389) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-10-07 |