| NPI | 1669568044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-080020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 37987) |
| 122300000X Dentist (Licence: OH 15995) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2011-03-18 |