| NPI | 1861426827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30026714) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 48787) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-05-23 |