| NPI | 1861578262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 17804) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.017804) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2016-10-03 |