| NPI | 1750408985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30016555) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 30016555) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2012-02-27 |