| NPI | 1588658041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.025286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5063) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2020-05-13 |