| NPI | 1801936190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14688) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-022475) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2014-02-17 |