| NPI | 1669642336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30023878) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4408) |
| 1223P0300X Dentist, Periodontics (Licence: SC 4408) | |
| 122300000X Dentist (Licence: OH 30023878) | |
| Enumeration Date | 2008-03-09 |
| Last Update Date | 2013-05-14 |