| NPI | 1861605677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-01-7805) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30017805) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-03-15 |