| NPI | 1538164405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-01-5892) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 28604) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-12-21 |