| NPI | 1659447183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30018631) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 18631) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2008-06-10 |