| NPI | 1811098098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 71.000252) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS36551) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2018-03-17 |