| NPI | 1922218486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.025555) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 8309) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2023-09-25 |