| NPI | 1609187764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2013010681) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.023266) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2013-07-15 |