| NPI | 1538420195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9177-D) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9177) |
| 122300000X Dentist (Licence: OH 30-024342) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2015-02-03 |