| NPI | 1831348713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 19767) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 28167) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |