| NPI | 1851526065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-023169) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH Resident: 2804) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2013-06-27 |