| NPI | 1891919973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013489) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30022701) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2010-12-27 |