| NPI | 1891866752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30021695) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-021695) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2021-01-04 |