| NPI | 1760447189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 013996) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN6499) |
| 122300000X Dentist (Licence: OH 0219865) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-07-08 |