| NPI | 1750784955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-024328) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN-21627) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2017-03-26 |