| NPI | 1689968190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.023657) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 19323) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2019-09-03 |