| NPI | 1528406659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH RES.3308) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020919) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2013-06-11 |