| NPI | 1649616616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30-023918) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023918) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2018-03-17 |