| NPI | 1588060420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013638) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.023870) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |