| NPI | 1578600714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS037434) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30022237) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2009-01-09 |