| NPI | 1912929142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 18504) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN 11813) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |