| NPI | 1851419030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30013232) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901017868) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |