| NPI | 1700842028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 17599) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-014134) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |