| NPI | 1730104399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30 01 1093) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30011093) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-09 |