| NPI | 1861470064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30022931) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009610) |
| 1223G0001X Dentist, General Practice (Licence: LA 5677) | |
| 1223G0001X Dentist, General Practice (Licence: TX 23189) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2009-07-27 |