| NPI | 1851555171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA ds038611) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022752) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2014-04-08 |