| NPI | 1659650109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30023826) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019028766) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2012-10-24 |