| NPI | 1629166087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 21973) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22408) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2019-02-01 |