| NPI | 1760652846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 1001438-15) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 16600) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2016-10-20 |